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Soares FLP, Ramos MH, Gramelisch M, de Paula Pego Silva R, da Silva Batista J, Cattafesta M, Salaroli LB. Intuitive eating is associated with glycemic control in type 2 diabetes. Eat Weight Disord 2021; 26:599-608. [PMID: 32232778 DOI: 10.1007/s40519-020-00894-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/21/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The intuitive eating approach has shown promise, but studies on its association with diabetics are scarce. The aim of this study is to identify the association between intuitive eating and glycemic control in individuals with type 2 diabetes mellitus. METHODS This is an observational cross-sectional analytical study in patients at the endocrinology service of a university hospital in Vitória/ES, Brazil. For data collection, a semi-structured questionnaire was used and intuitive eating was assessed by Intuitive Eating Scale-2. RESULTS A total of 179 individuals, mostly female and elderly, and predominantly taking oral antidiabetic drugs without association with insulin were evaluated. In adjusting for the total scale score, the most intuitive eating was associated with lower chances of patients presenting inadequate glycemic control by 89% (OR = 0.114; CI 0.024-0.540; p = 0.006), and a higher score on the Body-Food-Choice Congruence subscale was associated with lower chances of participants presenting this inadequacy by almost 66% (OR = 0.341; CI 0.131-0.891; p = 0.028), regardless of their body mass index. CONCLUSION Eating intuitively, especially in accordance with body needs may be associated with lower chances of type 2 diabetics having inadequate glycemic control. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Fabíola Lacerda Pires Soares
- Department of Integrated Health Education, Federal University of Espírito Santo, Marechal Campos Avenue, 1468, Maruípe, Vitória, ES, 29043, Brazil.
| | | | - Mariana Gramelisch
- Department of Integrated Health Education, Federal University of Espírito Santo, Marechal Campos Avenue, 1468, Maruípe, Vitória, ES, 29043, Brazil
| | - Rhaviny de Paula Pego Silva
- Department of Integrated Health Education, Federal University of Espírito Santo, Marechal Campos Avenue, 1468, Maruípe, Vitória, ES, 29043, Brazil
| | - Jussara da Silva Batista
- Department of Integrated Health Education, Federal University of Espírito Santo, Marechal Campos Avenue, 1468, Maruípe, Vitória, ES, 29043, Brazil
| | - Monica Cattafesta
- Graduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil
| | - Luciane Bresciani Salaroli
- Department of Integrated Health Education, Federal University of Espírito Santo, Marechal Campos Avenue, 1468, Maruípe, Vitória, ES, 29043, Brazil.,Graduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil.,Graduate Program in Nutrition and Health, Federal University of Espírito Santo, Vitória, Brazil
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The association between pre-conception intuitive eating and gestational weight gain. Eat Weight Disord 2021; 26:467-474. [PMID: 32125687 DOI: 10.1007/s40519-020-00878-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To determine if pre-conception intuitive eating, an adaptive eating behavior, was related to gestational weight gain (GWG) and the likelihood of exceeding GWG recommendations. METHODS This prospective survey study took place in an outpatient obstetric clinic. Participants completed the pre-conception Intuitive Eating Scale for Pregnancy during a prenatal check-up appointment and total GWG was collected from the medical record. The pre-conception Intuitive Eating Scale for Pregnancy assesses unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on hunger and satiety to inform what, when, and how much to eat. Hierarchical linear multiple regression and logistic multiple regression analyses determined associations between pre-conception intuitive eating and GWG on the total sample and stratified by weight status (normal/underweight, overweight, and obese). RESULTS The majority of the sample (n = 253) was white, married, employed, had annual household income > $50,000, and had a college degree. No aspects of pre-conception intuitive eating predicted the likelihood of excess GWG. However, in the total sample, unconditional permission to eat (subscale) was inversely related to total GWG (B = -0.16, p < 0.05). Among women with obesity (n = 36), eating for physical rather than emotional reasons (subscale) was inversely related to total GWG (B = -0.47, p < 0.05). DISCUSSION Some aspects of intuitive eating during the pre-conception period were related to total GWG, particularly for women with obesity. However, intuitive eating scores did not increase or decrease the likelihood of excess GWG. More research is needed to understand the mechanisms for this association before clinical recommendations can be made. LEVEL OF EVIDENCE Level III (Evidence obtained from well-designed cohort or case-control analytic studies).
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Zervos K, Koletsi M, Mantzios M, Skopeliti N, Tsitsas G, Naska A. An Eight-Week Mindful Eating Program Applied in a Mediterranean Population With Overweight or Obesity: The EATT Intervention Study. Psychol Rep 2021; 125:1011-1040. [PMID: 33583250 DOI: 10.1177/0033294120988104] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Overweight and obesity are important public health priorities. Mindful eating can contribute in preventing automatic eating behavior and emotional dysregulation, both being primary causes of overeating and negative body image. This research outlines an eight-week mindful eating intervention (i.e., project EATT) focusing on people with overweight or obesity in assisting positive behavioral, psychological and physiological change. METHODS Fifty-seven people residing in Athens were recruited to participate in this research, where participants were allocated to either an experimental or a waitlist condition. Changes in body weight, and eating attitude, mindfulness, self-compassion, anxiety questionnaires were administered at baseline and post-intervention, and at a 14-month follow-up. RESULTS Results indicated that mindfulness and self-compassion increased significantly, while anxiety symptoms decreased. Significance was also observed in reduction of overeating symptoms and oral control. While a negative relationship was observed between anxiety and mindfulness, and anxiety and self-compassion, self-compassion was negatively associated with overeating episodes. CONCLUSIONS The intervention improved participants' relationship with food and enabled changes towards successful weight regulation.
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Affiliation(s)
- Konstantinos Zervos
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marsha Koletsi
- Department of Psychology, 121340New York College, Athens, Greece
| | - Michael Mantzios
- School of Social Sciences, 1725Birmingham City University, Birmingham, UK
| | - Niki Skopeliti
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Androniki Naska
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Grider HS, Douglas SM, Raynor HA. The Influence of Mindful Eating and/or Intuitive Eating Approaches on Dietary Intake: A Systematic Review. J Acad Nutr Diet 2020; 121:709-727.e1. [PMID: 33279464 DOI: 10.1016/j.jand.2020.10.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Stimuli that promote eating in the absence of the physiological need for food are pervasive and can facilitate excessive energy intake. The practices of mindful eating (ME) and intuitive eating (IE) have been developed to minimize external drivers of energy intake by helping individuals emphasize the sensory properties of foods and internal indicators of hunger and fullness. OBJECTIVE To enhance understanding about the effect of ME and IE interventions on dietary intake, this systematic review included randomized trials of ME and IE interventions that examined dietary intake, defined as energy intake or diet quality, in adults of varying weight status without a diagnosis of an eating disorder. METHODS The selection of literature followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review process, in which PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases were searched for studies published between January 1980 and November 2019. Studies were included if they met the following criteria: randomized trial design in which 1 arm was an intervention with an ME or IE component and there was at least 1 control or active comparison arm; enrolled participants were of a healthy weight or with overweight or obesity and reported not having an eating disorder (ie, anorexia, bulimia nervosa, or binge eating disorder) or other health conditions in which dietary restrictions were applied; were at least 18 years of age; and outcomes of energy intake or diet quality were reported at baseline and post intervention. The modified Downs and Black checklist was used to assess risk of bias for each study that met inclusion criteria. RESULTS A total of 13 studies, including 8 investigating ME interventions and 5 investigating IE interventions, represented in 14 articles, were included in the review. Seven of the 9 articles reporting on energy intake did not find significant group differences. Eight of the 12 articles reporting on diet quality did not find significant group differences. The mean bias assessment score was 13.6 out of 28, indicating poor quality. CONCLUSIONS Little evidence suggests that ME and IE interventions influence energy intake or diet quality. To draw strong conclusions about the effect of ME and IE on dietary intake, future research using study designs of high rigor are needed.
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Affiliation(s)
- Hannah S Grider
- Department of Nutrition, University of Tennessee, Knoxville, TN
| | - Steve M Douglas
- Department of Nutrition, University of Tennessee, Knoxville, TN
| | - Hollie A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, TN.
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Preventing Nutritional Disorders in Adolescents by Encouraging a Healthy Relationship With Food. J Adolesc Health 2020; 67:875-879. [PMID: 33220798 DOI: 10.1016/j.jadohealth.2020.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
Nutritional disorders, including overweight, underweight, and/or nutrient deficiency, are a significant cause of morbidity and mortality. These disorders are frequently related to abnormal patterns of eating and/or physical activity, which commonly begin in adolescence and persist into adulthood. Abnormal eating and exercise behaviors may stem from an unhealthy relationship with food, which often takes root in preadolescence or early adolescence. To prevent eating disorders, overweight, underweight, and nutritional deficiencies in adolescence and beyond, health care providers need to proactively support early adolescents and their caregivers to develop a healthy relationship with food and their bodies. Anticipatory guidance, nutrition and exercise counseling, and encouragement of body positivity and healthy self-image during the vulnerable period of early adolescence can prevent maladaptive behaviors from emerging later on. Advocacy beyond the health care setting is also needed to ensure that adolescents are exposed to consistent and positive nutritional messaging. In this position article, authors from both the Nutrition/Obesity Committee and the Eating Disorder Committee of the Society of Adolescent Health and Medicine provide practical recommendations for health care professionals to guide their young patients and caregivers toward a flexible, balanced, and satisfying approach to nutrition that will lead to physical and emotional wellness throughout their lifetimes.
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Peitz D, Schulze J, Warschburger P. Getting a deeper understanding of mindfulness in the context of eating behavior: Development and validation of the Mindful Eating Inventory. Appetite 2020; 159:105039. [PMID: 33186622 DOI: 10.1016/j.appet.2020.105039] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/24/2020] [Accepted: 11/06/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Current research supports the effectiveness of mindfulness-based interventions for maladaptive eating behaviors associated with obesity and eating disorders. To investigate potential underlying mechanisms at work, reliable and valid instruments that allow for an exhaustive assessment of the context-specific construct Mindful Eating (ME) are needed. Therefore, the current work aimed to develop a comprehensive inventory reflecting a wide range of ME attitudes and behaviors: The Mindful Eating Inventory (MEI). METHODS & RESULTS Study 1 describes the item pool development for an initial version of the MEI comprising various steps (compilation of items, expert ratings, focus groups and think aloud protocols by laypersons). Within Study 2, the factor structure of this initial version was explored in an online sample of N = 828 participants and the item pool was shortened via a sequential process based on statistical and content-related considerations. Exploratory factor analyses yielded a seven-factor structure. This structure could be confirmed within Study 3 on an independent online sample of N = 612 participants using confirmatory factor analysis. Criterion validity was supported by hypotheses-confirming correlations with eating-specific and global health-relevant outcomes. CONCLUSION Our findings demonstrate that the MEI is a valid and reliable (in terms of internal consistency and retest-reliability) tool, which allows for a comprehensive assessment of various ME attitudes and behaviors within one parsimonious inventory. It further enabled us to propose a so far missing, initial scientific operational definition of this eating-specific construct, that may help to advance future research and clinical application by clarifying mechanisms of action.
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Affiliation(s)
- Diana Peitz
- Department of Psychology, Counseling Psychology, University of Potsdam, Karl-Liebknecht-Str. 24-25, Potsdam, 14476, Germany.
| | - Julian Schulze
- Division Psychological Assessment, Differential and Personality Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany
| | - Petra Warschburger
- Department of Psychology, Counseling Psychology, University of Potsdam, Karl-Liebknecht-Str. 24-25, Potsdam, 14476, Germany
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König LM, Sproesser G, Schupp HT, Renner B. Preference for Intuition and Deliberation in Eating Decision-making: Scale validation and associations with eating behaviour and health. Br J Health Psychol 2020; 26:109-131. [PMID: 33161619 DOI: 10.1111/bjhp.12460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 07/01/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Two distinct lines of research separately regard either deliberately regulated eating or intuitive eating as most beneficial for health. The present research aims to integrate these seemingly contradictory findings by investigating the relationships between Preference for Intuition and Deliberation in Eating Decision-making (E-PID) and subjective and objective health-related parameters using a newly developed scale. DESIGN Study 1: online survey; Study 2: cross-sectional community cohort sample. METHODS Study 1 (N = 699) assessed E-PID, intuitive, restrained, and external eating, motivation to eat healthily, domain-unspecific Preference for Intuition and Deliberation, and general self-control. Study 2 (N = 1,212) assessed E-PID, positive eating, intention to eat healthily, eating behaviour, and objective health risk factors (BMI, waist circumference, blood pressure, fasting serum glucose, HDL cholesterol, triglycerides). RESULTS Study 1 confirmed a two-factor structure and provided evidence for construct validity: A higher preference for intuition was positively related to intuitive eating, while a higher preference for deliberation was associated with increased dietary restraint. In Study 2, preference for deliberation was positively related to the intention to eat healthy, healthy eating behaviour, and health parameters. Preference for intuition was generally unrelated to health parameters, although a higher preference for intuition was related to a somewhat unhealthier eating pattern. CONCLUSIONS Preference for intuition and deliberation when making food choices are two distinct decision-making styles: The former focuses on internal cues, while the latter focuses on cognitive regulation of food intake. Despite these differences, neither decision-making style was shown to be detrimental.
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Affiliation(s)
- Laura M König
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Germany
| | - Gudrun Sproesser
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Germany
| | - Harald T Schupp
- General and Biological Psychology, Department of Psychology, University of Konstanz, Germany
| | - Britta Renner
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Germany
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Strategies designed to increase the motivation for and adherence to dietary recommendations in patients with chronic kidney disease. Nephrol Dial Transplant 2020; 36:2173-2181. [DOI: 10.1093/ndt/gfaa177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
Chronic kidney disease (CKD) often requires several dietary adjustments to control the disease-related disturbances. This is challenging for both patients and healthcare providers, and particularly for dietitians, who deal closely with the poor adherence to dietary recommendations. Factors associated with poor adherence within the CKD scenario and the need for a shift in the paradigm have already been indicated in several studies; however, rarely are any different and/or potential strategies actually formulated in order to change this paradigm. In this review, we aimed to explore the concepts and factors surrounding adherence to dietary recommendations in CKD and further describe certain potential strategies for a nutritional counseling approach. Such strategies, while poorly explored within CKD, have shown positive results in other chronic disease scenarios. It is timely, therefore, for healthcare providers to acquire these new counseling skills; nevertheless, this would require a rethinking of the traditional attitudes and approaches in order to build a partnership, based on a nonjudgmental and compassionate style in order to guide behavior change. The reflections presented in this review may contribute towards enhancing motivation and the adherence to dietary recommendations in CKD patients.
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Development and validation of the Multidimensional Internally Regulated Eating Scale (MIRES). PLoS One 2020; 15:e0239904. [PMID: 33031400 PMCID: PMC7544044 DOI: 10.1371/journal.pone.0239904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/15/2020] [Indexed: 01/07/2023] Open
Abstract
In this paper, we describe the systematic development and validation of the Multidimensional Internally Regulated Eating Scale (MIRES), a new self-report instrument that quantifies the individual-difference characteristics that together shape the inclination towards eating in response to internal bodily sensations of hunger and satiation (i.e., internally regulated eating style). MIRES is a 21-item scale consisting of seven subscales, which have high internal consistency and adequate to high two-week temporal stability. The MIRES model, as tested in community samples from the UK and US, had a very good fit to the data both at the level of individual subscales, but also as a higher-order formative model. High and significant correlations with measures of intuitive eating and eating competence lent support to the convergent validity of MIRES, while its incremental validity in relation to these measures was also upheld. MIRES as a formative construct, as well as all individual subscales, correlated negatively with eating disorder symptomatology and weight-related measures (e.g., BMI, weight cycling) and positively with adaptive behavioral and psychological outcomes (e.g., proactive coping, body appreciation, life satisfaction), supporting the criterion validity of the scale. This endeavor has resulted in a reliable and valid instrument to be used for the thorough assessment of the features that synthesize the profile of those who tend to regulate their eating internally.
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Garcia S, Valencia C, Amaro H. Cognitive Factors Associated with Frequency of Eating Out and Eating Takeout among Latinas. J Acad Nutr Diet 2020; 121:520-528. [PMID: 33028510 DOI: 10.1016/j.jand.2020.08.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Higher frequency of eating outside the home can be an unhealthy behavior that may contribute to higher rates of obesity among Latinas, a disproportionately affected group. There is a growing need to understand potentially modifiable factors (eg, dispositional mindfulness, self-efficacy, nutrition knowledge) associated with higher frequency of eating outside the home in this population. This study assessed associations of cognitive factors (ie, dispositional mindfulness, self-efficacy of eating and purchasing healthy foods, nutrition knowledge) with frequency of eating out among Latinas. A secondary analysis was performed of data from a cross-sectional study of Latinas between February and May 2015. The study comprised a convenience sample of 218 Spanish- or English-literate Latinas, between the ages of 18 and 55 years, who lived in South or East Los Angeles and self-identified as the primary person responsible for grocery shopping in the household. Most participants identified as foreign-born Mexican Americans. Frequency of eating out was assessed as the outcome variable, and three cognitive variables (mindfulness disposition, self-efficacy, nutrition knowledge) served as independent variables. Multinomial models assessed the association between cognitive factors and frequency of eating out. Models were adjusted for age, English-speaking ability, income, having an obesity-related disease (ie, overweight or obesity, diabetes, high blood pressure, cardiovascular disease), household size, and education level. For every 1-unit increase in mindfulness disposition, the risk of a participant eating out every week compared with every month decreased by a factor of 0.42 (relative risk ratio [RRR] = 0.58, P < 0.01). For every 1-unit increase in self-efficacy, the risk of a participant eating out every week compared with every month decreased by a factor of 0.32 (RRR = 0.68, P < 0.05), and the risk of a participant eating out every 2 weeks compared with every month decreased by a factor of 0.44 (RRR = 0.56, P < 0.05). For every 1-unit increase in nutrition knowledge, the risk of a participant eating out every week compared with every month increased by a factor of 1.42 (RRR = 1.42, P < 0.01). Lower dispositional mindfulness was associated with higher frequency of eating out when comparing individuals who ate out at least every week with those who ate out once a month or less or every 2 weeks. Lower self-efficacy was associated with eating out more when comparing those who ate out once a month or less with those who ate out at least every week or every 2 weeks. Lower nutrition knowledge was associated with lower frequency of eating out for participants who ate out once a month or less compared with those who ate out at least every week.
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Abstract
Internally regulated eating style, the eating style that is driven by internal bodily sensations of hunger and satiation, is a concept that has received increasing attention in the literature and health practice over the last decades. The various attempts that have been made so far to conceptualise internally regulated eating have taken place independently of one another, and each sheds light on only parts of the total picture of what defines internally regulated eating. This has resulted in a literature that is rather fragmented. More importantly, it is not yet clear which are the characteristics that comprise this eating style. In this paper, we identify and describe the full spectrum of these characteristics, namely, sensitivity to internal hunger and satiation signals, self-efficacy in using internal hunger and satiation signals, self-trusting attitude for the regulation of eating, relaxed relationship with food and tendency to savour the food while eating. With this research, we introduce a common language to the field and we present a new theoretical framework that does justice not just to the full breadth of characteristics that are necessary for the internally regulated eating style but also to the associations between them and the potential mechanisms by which they contribute to this eating style.
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Affiliation(s)
- Natalie D Ritchie
- Office of Research, Denver Health and Hospital Authority, Denver, CO .,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO .,University of Colorado College of Nursing, Aurora, CO
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Teaching people to eat according to appetite - Does the method of glucose measurement matter? Appetite 2020; 151:104691. [PMID: 32246953 DOI: 10.1016/j.appet.2020.104691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hunger training teaches people to eat according to their appetite using pre-prandial glucose measurement. Previous hunger training interventions used fingerprick blood glucose, however continuous glucose monitoring (CGM) offers a painless and convenient form of glucose monitoring. The aim of this randomised feasibility trial was to compare hunger training using CGM with fingerprick glucose monitoring in terms of adherence to the protocol, acceptability, weight, body composition, HbA1c, psychosocial variables, and the relationship between adherence measures and weight loss. METHODS 40 adults with obesity were randomised to either fingerpricking or scanning with a CGM and followed identical interventions for 6 months, which included 1 month of only eating when glucose was under their individualised glucose cut-off. For months 2-6 participants relied on their sensations of hunger to guide their eating and filled in a booklet. RESULTS 90% of the fingerpricking group and 85% of the scanning group completed the study. Those using the scanner measured their glucose an extra 1.9 times per day (95% CI 0.9, 2.8, p < 0.001) compared with those testing by fingerprick. Both groups lost similar amounts of weight over 6 months (on average 4 kg), were satisfied with the hunger training program and wanted to measure their glucose again within the next year. There were no differences between groups in terms of intervention acceptability, weight, body composition, HbA1c, eating behaviours, or psychological health. Frequency of glucose testing and booklet entry both predicted a clinically meaningful amount of weight loss. CONCLUSIONS Either method of measuring glucose is effective for learning to eat according to hunger using the hunger training program. As scanning with a CGM encouraged better adherence to the protocol without sacrificing outcome results, future interventions should consider using this new technology in hunger training programs.
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Roesler A, Nishi N. An exploration using system dynamics modelling of population-level mindfulness, mindful eating and healthy weight following intervention. Nutr Health 2020; 26:179-186. [PMID: 32308110 DOI: 10.1177/0260106020917290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mindful eating has been introduced as a strategy to help prevent overweight and obesity. AIM The purpose of this research was to develop a simple system dynamics model to investigate the impact of different interventions on population level mindfulness, mindful eating and healthy weight over a 10-year period. METHODS A model was constructed and outcomes analysed following the addition of four mindful eating interventions, including decreasing busyness (formal and informal work), promotion of mindful eating (e.g. classes and media), promotion of mindfulness, reduction of external eating cues (decreased portion sizes and variety) or a combination of all interventions. RESULTS The model projected that if the current situation was to continue over the next 10-year period, there would be a small decrease of 0.6% in the healthy-weight population despite a 42% increase in people practising mindfulness and 40% increase in people eating mindfully. Of the four interventions introduced, decreasing busyness had the greatest impact on the number of people practising mindfulness, eating mindfully and of a healthy weight. However, when all four interventions were introduced together this resulted in the greatest (19%) increase in the proportion of healthy-weight people. CONCLUSIONS The study suggests that mindful eating can be improved through intervention, however, the interventions will not greatly contribute to improving the healthy-weight population unless implemented in combination.
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Affiliation(s)
- Anna Roesler
- International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Japan
| | - Nobuo Nishi
- International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Japan
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Gale JT, Ward AL, de Bruin WE, Taylor RW, Jospe MR. Translating hunger training research to primary health: a qualitative study of nurse attitudes towards a novel weight management intervention. J Prim Health Care 2020; 12:79-87. [PMID: 32223854 DOI: 10.1071/hc19052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/02/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Practice nurses in general practice are ideally placed to deliver weight management treatments. Teaching people to eat according to their appetite, based on measurements of blood glucose ('hunger training'), is known to lead to weight loss and improved eating behaviour. To effectively translate this research to primary care requires understanding of key stakeholder perspectives. AIM The aim of this study was to explore the perspectives of practice nurses on the suitability of using hunger training as a weight management intervention in general practice. METHODS Ten nurses trialled hunger training for 1 week, followed by a semi-structured interview where they were asked about their experience; perceived patient interest; enablers and barriers; and suggested changes to hunger training. RESULTS All nurses were positive about hunger training and wanted to use it with their patients. They thought it was a useful method for teaching patients about eating according to their appetite, and the impact of food choices on glucose. Motivation was seen to be both an important potential barrier and enabler for patients. Other anticipated patient enablers included the educational value of hunger training and ease of the programme. Other barriers included lack of time and cost of equipment and appointments. For most nurses, 1 week of following hunger training was sufficient training to deliver the intervention. Suggested refinements included adding nutrition advice to the booklet, incorporating other health goals and enabling social support. DISCUSSION These findings suggest that hunger training could be translated to primary care with minor modifications.
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Affiliation(s)
- Jennifer T Gale
- Department of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Aimee L Ward
- Department of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Willemijn E de Bruin
- Department of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Rachael W Taylor
- Department of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Michelle R Jospe
- Department of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand; and Corresponding author.
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Aboueid S, Pouliot C, Hermosura BJ, Bourgeault I, Giroux I. Dietitians' Perspectives on the Impact of Multidisciplinary Teams and Electronic Medical Records on Dietetic Practice for Weight Management. CAN J DIET PRACT RES 2020; 81:2-7. [PMID: 31081677 DOI: 10.3148/cjdpr-2019-015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: To understand the perception of dietitians regarding the effects of multidisciplinary settings and Electronic Health Records (EHRs) on their dietetic practice for weight management. Methods: Individual semi-structured interviews were conducted with 14 dietitians working in multidisciplinary settings in Ontario. All interviews were audio recorded and transcribed verbatim. Two researchers coded the data independently using a thematic analysis approach. All themes emerged inductively and were refined iteratively. Results: Most dietitians believed that working in a multidisciplinary setting allowed for interprofessional collaboration and time-effective referrals. Multidisciplinary clinics were perceived to improve patient care due to convenient scheduling, consistent messaging, and ongoing support. However, some dietitians reported instances of conflicting approaches and beliefs regarding weight management across health professionals. Dietitians suggested ways to address these conflicting approaches through clinical meetings and education. EHRs were perceived to allow for collaboration through facilitated communication and knowledge exchange; however, lack of interoperability between EHR platforms across different types of health care settings was perceived to be a barrier for optimal care. Conclusions: Overall, multidisciplinary settings were perceived to positively impact dietitians' practices for weight management as they allow for interprofessional collaboration. Consistency in health messaging across health professionals should be emphasized through knowledge exchange.
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Affiliation(s)
- Stephanie Aboueid
- Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | | | | | - Ivy Bourgeault
- Health Systems Management, University of Ottawa, Ottawa, ON
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Knowles D, Brown K, Aldrovandi S. Exploring the roles of physical effort and visual salience within the proximity effect. Appetite 2020; 145:104489. [DOI: 10.1016/j.appet.2019.104489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 12/30/2022]
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Ritchie ND, Baucom KJW, Sauder KA. Current Perspectives on the Impact of the National Diabetes Prevention Program: Building on Successes and Overcoming Challenges. Diabetes Metab Syndr Obes 2020; 13:2949-2957. [PMID: 32903871 PMCID: PMC7445538 DOI: 10.2147/dmso.s218334] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
To address the public health and economic burden of type 2 diabetes, the Centers for Disease Control and Prevention (CDC) began dissemination of the National Diabetes Prevention Program (NDPP) in the United States in 2010. Based on the intensive lifestyle intervention from a large efficacy trial, the NDPP aims to reduce incidence through lifestyle change and weight loss. This narrative review summarizes evidence on reach, effectiveness, and sustainability of the NDPP, while highlighting opportunities to overcome challenges in these areas. Major successes include reaching hundreds of thousands of at-risk individuals across the nation, with notable effectiveness upon full participation and widespread insurance coverage. Yet, more work is needed to ensure greater public health impact, particularly among priority populations at heightened risk who also experience disparities in program outcomes. Preliminary evidence suggests a number of strategies may improve reach and effectiveness of the NDPP, often with more rigorous study needed prior to widespread uptake. Updating the NDPP to better match the current evidence-base may also be important, such as directly targeting glycemia with a patient-centered approach and promoting metformin as an adjunct or second-line treatment. Finally, revisiting pay-for-performance reimbursement models may be critical to sustainability by ensuring adequate availability of suppliers and ultimately reducing diabetes prevalence.
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Affiliation(s)
- Natalie D Ritchie
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- University of Colorado College of Nursing, Aurora, CO, USA
- Correspondence: Natalie D Ritchie Denver Health and Hospital Authority Email
| | | | - Katherine A Sauder
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
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69
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Moran PM, Bunn A. Practitioners’ perceptions of implementing psychotherapeutic weight loss groups in a culturally diverse, deprived area: working with differences. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2019. [DOI: 10.1080/03069885.2019.1703900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Patricia M. Moran
- HCPC Registered Counselling Psychologist and BPS Chartered Psychologist in Private Clinical Practice, London, UK
| | - Amanda Bunn
- Centre for Abuse and Trauma Studies, Middlesex University, London, UK
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Fagnant HS, Armstrong NJ, Lutz LJ, Nakayama AT, Guerriere KI, Ruthazer R, Cole RE, McClung JP, Gaffney-Stomberg E, Karl JP. Self-reported eating behaviors of military recruits are associated with body mass index at military accession and change during initial military training. Appetite 2019; 142:104348. [DOI: 10.1016/j.appet.2019.104348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/04/2019] [Accepted: 07/03/2019] [Indexed: 12/13/2022]
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Keirns NG, Hawkins MAW. Intuitive eating, objective weight status and physical indicators of health. Obes Sci Pract 2019; 5:408-415. [PMID: 31687166 PMCID: PMC6819977 DOI: 10.1002/osp4.359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Intuitive eating (IE) has emerged as a weight-neutral approach to health promotion for those with overweight/obesity. This weight-neutral paradigm has some support, although research thus far has often neglected to control for potential confounds (i.e. objective weight status and demographics) and foundational studies are lacking. The objective of the current study was to observe the unique association of IE with physical health indicators in a sample of adults, independent of objective weight status. METHODS Participants were 248 adults (32 ± 14 years old, 73% female, 64% White) of all weight categories (18.2-55.3 kg m-2), with an average body mass index (BMI) of 30 ± 8 kg m-2. IE was measured with the Intuitive Eating Scale-2 (IES-2). BMI was objectively measured in-lab. Health indicators included blood pressure (BP) and fasting glucose. RESULTS A series of hierarchical linear regressions revealed no significant associations between IE and systolic BP (β = -0.076, P = 0.256), diastolic BP (DBP; β = -0.122, P = 0.073) or fasting glucose (β = 0.047, P = 0.500) after controlling for BMI. All effects sizes were small or below (f 2 = 0.00 to -0.04). Sensitivity analyses revealed significantly lower DBP in high intuitive eaters versus low when analysed with a t-test, t(111.651) = 3.602, P < 0.001, Levene corrected; however, after controlling for relevant covariates (i.e. BMI and demographics), analysis of covariance revealed no difference in DBP between groups, F(1, 116) = 0.330, P = 0.567. No significant differences in systolic BP or fasting glucose were observed between low and high intuitive eaters before or after considering covariates. CONCLUSIONS In sum, this study investigated associations between IE and common indicators of physical health after controlling for objective weight status. Findings revealed no unique relationship between IE and physical health, and any IE-physical health relationships that were observed were accounted for BMI and/or demographic factors.
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Affiliation(s)
- N. G. Keirns
- Department of PsychologyOklahoma State UniversityStillwaterOKUSA
| | - M. A. W. Hawkins
- Department of PsychologyOklahoma State UniversityStillwaterOKUSA
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Khasteganan N, Lycett D, Furze G, Turner AP. Health, not weight loss, focused programmes versus conventional weight loss programmes for cardiovascular risk factors: a systematic review and meta-analysis. Syst Rev 2019; 8:200. [PMID: 31400767 PMCID: PMC6689181 DOI: 10.1186/s13643-019-1083-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 07/02/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Obesity is a cardiovascular disease risk factor. Conventional weight loss (CWL) programmes focus on weight loss, however 'health, not weight loss, focused' (HNWL) programmes concentrate on improved health and well-being, irrespective of weight loss. What are the differences in CVD risk outcomes between these programmes? AIM To conduct a systematic review and meta-analysis to compare the effects of HNWL with CWL programmes on cardiovascular disease risk factors. METHODS We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, clinical trial registers, commercial websites and reference lists for randomised controlled trials comparing the two programmes (initially searched up to August 2015 and searched updated to 5 April 2019). We used the Mantel-Haneszel fixed-effect model to pool results. Sub-group and sensitivity analyses that accounted for variations in length of follow-up, enhanced programmes and risk of bias dealt with heterogeneity. RESULTS Eight randomised controlled trials of 20,242 potential studies were included. Improvements in total cholesterol-HDL ratio (mean difference - 0.21 mmol/L, 95% confidence interval [- 3.91, 3.50]) and weight loss (- 0.28 kg [- 2.00, 1.44]) favoured HNWL compared to CWL programmes in the long term (53-104 week follow-up), whereas improvements in systolic (- 1.14 mmHg, [- 5.84, 3.56]) and diastolic (- 0.15 mmHg, [- 3.64, 3.34]) blood pressure favoured CWL programmes. These differences did not reach statistical significance. Statistically significant improvements in body satisfaction (- 4.30 [- 8.32, - 0.28]) and restrained eating behaviour (- 4.30 [- 6.77, - 1.83]) favoured HNWL over CWL programmes. CONCLUSIONS We found no long-term significant differences in improved CVD risk factors; however, body satisfaction and restrained eating behaviour improved more with HNWL compared to CWL programmes. Yet firm conclusions cannot be drawn from small studies with high losses to follow-up and data sometimes arising from a single small study. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015019505.
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Affiliation(s)
| | - Deborah Lycett
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
| | - Gill Furze
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Andy P Turner
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Beintner I, Emmerich OLM, Vollert B, Taylor CB, Jacobi C. Promoting positive body image and intuitive eating in women with overweight and obesity via an online intervention: Results from a pilot feasibility study. Eat Behav 2019; 34:101307. [PMID: 31220739 DOI: 10.1016/j.eatbeh.2019.101307] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Body dissatisfaction and dietary restraint are established risk factors for eating disorders and are also prevalent in individuals who are overweight and obese. Studies have shown that online prevention programs can lower these risk factors. The aim of this feasibility pilot study was to estimate effects of a 12-week online health promotion and eating disorder prevention program in a sample of women with overweight or obesity, but without binge eating. METHODS The program was evaluated in an uncontrolled pre-post-follow-upstudy over 12 months. Outcome measures were eating disorder related cognitions and attitudes. Participants were recruited via flyers, online posts, press releases, and mailings through cooperating health insurances. RESULTS 371 women who completed the screening met the inclusion criteria. 323 women took part in the baseline assessment and were granted access to the intervention. 50 women completed all sessions. An intention-to-treat analysis showed significant and long-term reductions in weight and shape concerns, restrictive eating and increases in life satisfaction and self-esteem (d = 0.31-0.86), and a short-term increase in fruit and vegetable consumption (d = 0.70). CONCLUSION everyBody fit seems a feasible program for improving body image and reducing disordered eating in overweight and obese women, with medium to large effects on various outcomes. The efficacy of the intervention needs to be established in a randomized controlled trial.
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Affiliation(s)
- Ina Beintner
- Chair of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, 01062 Dresden, Germany.
| | | | - Bianka Vollert
- Chair of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, 01062 Dresden, Germany
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA; Center for m(2) Health, Palo Alto University, Palo Alto, CA, USA
| | - Corinna Jacobi
- Chair of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, 01062 Dresden, Germany
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Wehling H, Lusher JM. Cognitive and Emotional Influences on Eating Behaviour: A Qualitative Perspective. Nutr Metab Insights 2019; 12:1178638819855936. [PMID: 31384129 PMCID: PMC6647198 DOI: 10.1177/1178638819855936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022] Open
Abstract
Considering that individuals who are within a healthy weight range may experience different thoughts about food to those who are already overweight or obese triggers the need to understand the nature, challenges, and coping strategies of food-related thinking styles in this population in relation to those who are either overweight or obese. Analysis of 6 semi-structured qualitative interviews with individuals who are either at risk of being overweight (body mass index [BMI] = 23-24.99), or above a healthy weight (BMI ⩾ 25), revealed 3 overarching themes: (1) Why am I all about food? (2) Jekyll and Hyde, and (3) Emotional attachment to food. These findings highlighted a link between dieting and negative thinking, which foster unhealthy eating patterns. Therefore, intuitive eating may offer a useful alternative to re-establish a healthier relationship with food.
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Affiliation(s)
- Helena Wehling
- School of Psychology, London Metropolitan University, UK
| | - Joanne M Lusher
- School of Health & Life Sciences, University of the West of Scotland, London, UK
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Dijker AJM. Moderate eating with pleasure and without effort: Toward understanding the underlying psychological mechanisms. Health Psychol Open 2019; 6:2055102919889883. [PMID: 31798937 PMCID: PMC6873279 DOI: 10.1177/2055102919889883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Integrating research on elementary eating behaviors, savoring, mental imagery, mindfulness, cooking, and dinner rituals, a psychological theory of moderate eating is formulated that does not require effortful self-control and giving up on the pleasures of eating. The theory proposes that taste and pleasure can be combined with a relatively objective attitude toward food, resulting in a relatively slow, gentle, and thoughtful manner of eating that enhances satiation. The objective food attitude is thought to result from (a) the accumulation of multiple sensorimotor expectancies and perspectives and (b) a motivational mechanism underlying prosocial behavior, food sharing, and aggression-inhibiting dinner rituals.
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H Al Wattar B, Dodds J, Placzek A, Beresford L, Spyreli E, Moore A, Gonzalez Carreras FJ, Austin F, Murugesu N, Roseboom TJ, Bes-Rastrollo M, Hitman GA, Hooper R, Khan KS, Thangaratinam S. Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): A pragmatic multicentre randomised trial. PLoS Med 2019; 16:e1002857. [PMID: 31335871 PMCID: PMC6650045 DOI: 10.1371/journal.pmed.1002857] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/19/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pregnant women with metabolic risk factors are at high risk of complications. We aimed to assess whether a Mediterranean-style diet reduces adverse pregnancy outcomes in high-risk women. METHODS AND FINDINGS We conducted a multicentre randomised trial in 5 maternity units (4 in London and 1 in Birmingham) between 12 September 2014 and 29 February 2016. We randomised inner-city pregnant women with metabolic risk factors (obesity, chronic hypertension, or hypertriglyceridaemia) to a Mediterranean-style diet with high intake of nuts, extra virgin olive oil, fruits, vegetables, nonrefined grains, and legumes; moderate to high consumption of fish; low to moderate intake of poultry and dairy products; low intake of red and processed meat; and avoidance of sugary drinks, fast food, and food rich in animal fat versus usual care. Participants received individualised dietary advice at 18, 20, and 28 weeks' gestation. The primary endpoints were composite maternal (gestational diabetes or preeclampsia) and composite offspring (stillbirth, small for gestational age, or admission to neonatal care unit) outcomes prioritised by a Delphi survey. We used an intention-to-treat (ITT) analysis with multivariable models and identified the stratification variables and prognostic factors a priori. We screened 7,950 and randomised 1,252 women. Baseline data were available for 593 women in the intervention (93.3% follow-up, 553/593) and 612 in the control (95.6% follow-up, 585/612) groups. Over a quarter of randomised women were primigravida (330/1,205; 27%), 60% (729/1,205) were of Black or Asian ethnicity, and 69% (836/1,205) were obese. Women in the intervention arm consumed more nuts (70.1% versus 22.9%; adjusted odds ratio [aOR] 6.8, 95% confidence interval [CI] 4.3-10.6, p ≤ 0.001) and extra virgin olive oil (93.2% versus 49.0%; aOR 32.2, 95% CI 16.0-64.6, p ≤ 0.001) than controls; increased their intake of fish (p < 0.001), white meat (p < 0.001), and pulses (p = 0.05); and reduced their intake of red meat (p < 0.001), butter, margarine, and cream (p < 0.001). There was no significant reduction in the composite maternal (22.8% versus 28.6%; aOR 0.76, 95% CI 0.56-1.03, p = 0.08) or composite offspring (17.3% versus 20.9%; aOR 0.79, 95% CI 0.58-1.08, p = 0.14) outcomes. There was an apparent reduction in the odds of gestational diabetes by 35% (aOR 0.65, 95% CI 0.47-0.91, p = 0.01) but not in other individual components of the composite outcomes. Mothers gained less gestational weight (mean 6.8 versus 8.3 kg; adjusted difference -1.2 Kg, 95% CI -2.2 to -0.2, p = 0.03) with intervention versus control. There was no difference in any of the other maternal and offspring complications between both groups. When we pooled findings from the Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes (ESTEEM) trial with similar trials using random effects meta-analysis, we observed a significant reduction in gestational diabetes (odds ratio [OR] 0.67, 95% CI 0.53-0.84, I2 = 0%), with no heterogeneity (2 trials, 2,397 women). The study's limitations include the use of participant reported tools for adherence to the intervention instead of objective biomarkers. CONCLUSIONS A simple, individualised, Mediterranean-style diet in pregnancy did not reduce the overall risk of adverse maternal and offspring complications but has the potential to reduce gestational weight gain and the risk of gestational diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT02218931.
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Affiliation(s)
- Bassel H Al Wattar
- BARC (Barts Research Centre for Women's Health), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Julie Dodds
- BARC (Barts Research Centre for Women's Health), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Anna Placzek
- BARC (Barts Research Centre for Women's Health), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Lee Beresford
- Pragmatic Clinical Trials Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Eleni Spyreli
- BARC (Barts Research Centre for Women's Health), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Amanda Moore
- Diabetes & Nutritional Sciences Division, Faculty of Life Sciences & Medicine, King's College, London, United Kingdom
| | - Francisco J Gonzalez Carreras
- BARC (Barts Research Centre for Women's Health), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Frances Austin
- Maternity Dietetic Service, Women's and Children's Services, Barts NHS Trust, London, United Kingdom
| | - Nilaani Murugesu
- BARC (Barts Research Centre for Women's Health), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Tessa J Roseboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands.,Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain.,IDISNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Graham A Hitman
- Barts Diabetes and Obesity Research Group, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Richard Hooper
- Pragmatic Clinical Trials Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Khalid S Khan
- BARC (Barts Research Centre for Women's Health), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Multidisciplinary Evidence Synthesis Hub (mEsh), Blizard Institute, Barts and the London School of Medicine, Queen Mary University London, London, United Kingdom
| | - Shakila Thangaratinam
- BARC (Barts Research Centre for Women's Health), Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Multidisciplinary Evidence Synthesis Hub (mEsh), Blizard Institute, Barts and the London School of Medicine, Queen Mary University London, London, United Kingdom
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Lee MF, Williams SL, Burke KJ. Striving for the thin ideal post-pregnancy: a cross-sectional study of intuitive eating in postpartum women. J Reprod Infant Psychol 2019; 38:127-138. [DOI: 10.1080/02646838.2019.1607968] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Megan F. Lee
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
- School of Health and Human Sciences, Southern Cross University, Bilinga, Australia
| | - Susan L. Williams
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Karena J. Burke
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
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The relationship between intuitive eating and body image is moderated by measured body mass index. Eat Behav 2019; 33:91-96. [PMID: 31048247 PMCID: PMC6535356 DOI: 10.1016/j.eatbeh.2019.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022]
Abstract
Intuitive eating (IE) is a pattern of adaptive eating that has been associated with positive psychosocial and physical factors (e.g., positive body image, lower body mass index; BMI). However, BMI has also been negatively associated with body image. Our goal was to evaluate whether IE is uniquely associated with body image, independent of objective weight status (measured BMI). Further, as a secondary aim, this study analyzed potential moderators (BMI, sex, race-ethnicity) in the IE-body image relationship. Data from 136 adults (34 ± 15 years old, 74% female, 56% Caucasian) were analyzed. BMI was objectively measured in-lab. IE was measured with the Intuitive Eating Scale-2. Body image was measured as a Body Concern composite created using the Eating Disorder Examination-Questionnaire (EDE-Q 6.0) Weight and Shape Concern subscales. Demographic factors and covariates were measured via self-report. Regressions revealed that, after controlling for BMI and covariates, Total IE was uniquely associated with Body Concern (β = -0.463, p < .001), as were two of the IE subscales: Unconditional Permission to Eat (Unconditional Permission; β = -0.320, p < .001) and Eating for Physical Rather than Emotional Reasons (Physical Reasons; β = -0.408, p < .001). BMI was also found to be a significant moderator between IE and Body Concern for Total IE (b = 0.071, p = .017), Unconditional Permission (b = 0.067, p = .001), and Physical Reasons (b = 0.038, p = .021), with the negative association between IE and Body Concern being strongest for healthy weight individuals. Greater IE was associated with lower body image concern across the weight spectrum, though this relationship was strongest for healthy weight individuals and attenuated as BMI increased.
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79
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Dumas AA, Desroches S. Women's Use of Social Media: What Is the Evidence About Their Impact on Weight Management and Body Image? Curr Obes Rep 2019; 8:18-32. [PMID: 30666619 DOI: 10.1007/s13679-019-0324-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF THE REVIEW This review aims to summarize recent research on the effects of social media-delivered weight management interventions on weight loss and the impact of social media use on body image concerns in women and adolescent girls. RECENT FINDINGS Evidence supports the feasibility, but not the efficacy, of studies using single-component social media-delivered weight management interventions (i.e., including no other modes of intervention delivery) in women. Studies conducted in adolescent girls and women suggest that the impact of social media on body image outcomes is mostly detrimental, but is dependent on the context (e.g., exposure to idealized social media appearance images), peers' feedback, and constructs, such as appearance comparison tendency. More research is needed to conclude on the efficacy of social media-delivered interventions on both weight and body image outcomes and to understand how and when exposure to social media could promote effective weight management and also advocate positive body image in women.
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Affiliation(s)
- Audrée-Anne Dumas
- Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Sophie Desroches
- Institute of Nutrition and Functional Foods, School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada.
- Université Laval, Pavillon des services, Office 2729-P, 2440 Hochelaga Boulevard, Quebec City, Quebec, G1V 0A6, Canada.
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Willer F, Hannan-Jones M, Strodl E. Australian dietitians' beliefs and attitudes towards weight loss counselling and health at every size counselling for larger-bodied clients. Nutr Diet 2019; 76:407-413. [PMID: 30811815 DOI: 10.1111/1747-0080.12519] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/13/2019] [Accepted: 01/28/2019] [Indexed: 01/17/2023]
Abstract
AIM Research suggests that dietitians now employ weight-neutral (WN) approaches (Health at Every Size (HAES), Intuitive Eating and non-diet) as well as more traditional weight-centric (WC) approaches (weight loss counselling) to address adult weight concerns. This study aimed to compare the knowledge of and attitudes towards WN practice compared with WC practice in Australian dietitians who work with larger-bodied clients as delineated by practice approach. METHODS A cross-sectional web-based knowledge, attitudes and practices survey was conducted with Australian dietitians who counsel adults with a body mass index >25 kg/m2 . Based on their responses, dietitians were categorised into WC (preferring weight loss counselling), WN (preferring HAES counselling) or mixed approach (MA). Between-group comparisons were conducted using Pearson's chi- squared tests for knowledge and practice and independent t-tests for attitudes. RESULTS Of the 317 respondents, 18.3% fulfilled the criteria for WN practitioners, 30.3% for WC practitioners and the remainder were classified as providing a MA. Weight-neutral approaches were more positively regarded generally than WC approaches (84.5% vs 53.9%) as well as considered professionally responsible (86% vs 58.7%) and perceived as more helpful for clients (61.2% vs 35%). Knowledge of WN practice goals was poor with only 36.9% (n = 117) of the participants indicating correctly that this mode of treatment is incompatible with a weight loss goal. CONCLUSIONS Weight-neutral practice was considered acceptable by Australian dietetics professionals who counsel larger-bodied people regardless of their personal practice preference although many displayed inaccurate knowledge of WN approaches.
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Affiliation(s)
- Fiona Willer
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mary Hannan-Jones
- School of Exercise and Nutrition Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Esben Strodl
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Purton T, Mond J, Cicero D, Wagner A, Stefano E, Rand-Giovannetti D, Latner J. Body dissatisfaction, internalized weight bias and quality of life in young men and women. Qual Life Res 2019; 28:1825-1833. [DOI: 10.1007/s11136-019-02140-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 12/20/2022]
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82
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Barraclough EL, Hay-Smith EJC, Boucher SE, Tylka TL, Horwath CC. Learning to eat intuitively: A qualitative exploration of the experience of mid-age women. Health Psychol Open 2019; 6:2055102918824064. [PMID: 30746153 PMCID: PMC6360478 DOI: 10.1177/2055102918824064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Qualitative studies examining women's experiences of learning to eat more intuitively are scarce. We aimed to explore the experience of learning intuitive eating among mid-age women (n = 11) who participated in a web-based intuitive eating programme. Motivation to learn intuitive eating, perceptions of the experience of attempting to eat more intuitively, and facilitators and barriers to intuitive eating were explored using inductive thematic analysis. Findings suggest that women were able to learn to eat more intuitively; however, they encountered social and environmental barriers, and the 'unconditional permission to eat' aspect of intuitive eating was experienced as the most challenging.
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83
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Cole RE, Meyer SA, Newman TJ, Kieffer AJ, Wax SG, Stote K, Madanat H. The My Body Knows When Program Increased Intuitive Eating Characteristics in a Military Population. Mil Med 2019; 184:e200-e206. [DOI: 10.1093/milmed/usy403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/20/2018] [Indexed: 12/17/2022] Open
Abstract
Abstract
Introduction
The purpose of this pilot study was to assess the effectiveness of the revised My Body Knows When (MBKW) program to promote intuitive eating behaviors within a sample of a military population through an online or in-person delivery mode.
Materials and Methods
Fifty-six overweight or obese adults (70% female); military service members (20%), retirees (38%) and family (42%) participated in the 10-week MBKW program at two military installations from 2012 to 2014. Body Mass Index, Intuitive Eating Scale-2 (IES-2; 23-item) and Motivation for Eating scale (MFES; 43-item) were collected at baseline and 10-weeks. Data were stratified by sex. Descriptive data were reported as mean ± standard deviation (SD), frequency, or percentage. A paired t-test was conducted with data at baseline and 10 weeks (α = 0.05, 80% power).
Results
Participants were predominantly female (70%); mean age of 51 ± 13 years; and BMI of 34.1 ± 5.5 kg/m2. There were no demographic, MFES, or IES-2 baseline differences between groups (in-person vs. online) or location. All subjects were collapsed into one group for a pre-post MBKW implementation assessment due to small sample size despite the original intent to stratify by online and in-person grouping. At 10 weeks, the remaining 26 participants exhibited a significant improvement (mean ± SD) in BMI (−0.4 ± 0.6 kg/m2; p = 0.012), environmental/social eating score (2.7 ± 0.4 points [pts]; −0.5 pt change; p < 0.001), emotional eating score (2.2 ± 0.5 pts; −0.6 pt change; p = 0.001), unconditional permission to eat score (3.4 ± 0.4 pts; +0.3 pt change; p = 0.017), eating for physical rather than emotional eating score (3.7 ± 0.8 pts; +1.0 pt change; p < 0.001), and reliance on hunger and satiety cues score (3.6 ± 0.5 pts; +0.8 pt change; p = 0.001). High attrition rates at the 10-week follow-up assessment precluded accurate assessment of long-term intervention effects.
Conclusions
The MBKW program was associated with improved intuitive eating behaviors and with less external eating influence on behavior; however, a larger sample is required to assess the effectiveness of MBKW delivery mode. Modest weight loss was attained but testing the efficacy of the MBKW program in a large diverse sample with alternate scenarios may be worthwhile (e.g., primary prevention against weight gain, or during weight maintenance to prevent weight regain).
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Affiliation(s)
- Renee E Cole
- U.S. Military-Baylor Graduate Program in Nutrition, AMEDD C&S, HRCoE, 3599 Winfield-Scott Rd, JBSA-Fort Sam Houston, TX
| | - Stephanie A Meyer
- U.S. Military-Baylor Graduate Program in Nutrition, AMEDD C&S, HRCoE, 3599 Winfield-Scott Rd, JBSA-Fort Sam Houston, TX
| | - Taylor J Newman
- U.S. Military-Baylor Graduate Program in Nutrition, AMEDD C&S, HRCoE, 3599 Winfield-Scott Rd, JBSA-Fort Sam Houston, TX
- Army Specialist Corps Office of the Chief, 3630 Stanley Road, Suite 276, JBSA-Fort Sam Houston, TX
| | - Adam J Kieffer
- U.S. Military-Baylor Graduate Program in Nutrition, AMEDD C&S, HRCoE, 3599 Winfield-Scott Rd, JBSA-Fort Sam Houston, TX
| | - Sarah G Wax
- U.S. Military-Baylor Graduate Program in Nutrition, AMEDD C&S, HRCoE, 3599 Winfield-Scott Rd, JBSA-Fort Sam Houston, TX
- Moncrief Army Health Clinic, 4500 Stuart St, Fort Jackson, SC
| | - Kim Stote
- Health Sciences, State University of New York, Empire State College, 113 West Ave, Saratoga Springs, NY
| | - Hala Madanat
- Graduate School of Public Health, San Diego State University, 5000 Campanile Dr, MC 4162, San Diego, CA
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84
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Calogero RM, Tylka TL, Mensinger JL, Meadows A, Daníelsdóttir S. Recognizing the Fundamental Right to be Fat: A Weight-Inclusive Approach to Size Acceptance and Healing From Sizeism. WOMEN & THERAPY 2018. [DOI: 10.1080/02703149.2018.1524067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Tracy L. Tylka
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Janell L. Mensinger
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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85
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Horwath C, Hagmann D, Hartmann C. Intuitive eating and food intake in men and women: Results from the Swiss food panel study. Appetite 2018; 135:61-71. [PMID: 30584896 DOI: 10.1016/j.appet.2018.12.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
Although intuitive eating (IE) interventions have consistently shown benefits for psychological wellbeing and some have shown improvements in physical wellbeing, there is scarce information on the relationship between IE and food intake. Given the popularity of IE as an alternative to dieting, it's important to explore its relationship with food intake. The relationships between IE, Body Mass Index (BMI), diet quality, self-evaluation of dietary intake and physical activity were investigated. A randomly selected sample of adults from the German and French-speaking parts of Switzerland (N = 5,238, 51% men, 20-100 years, BMI 15-62 kg/m2) completed a self-administered questionnaire comprising measures of a diverse range of eating related variables. Intuitive Eating was assessed with the IES-2. Food intake was measured with a semiquantitative food frequency questionnaire. Pearson correlations between the IES-2 and variables of interest were calculated for men and women separately. Although total IES-2 scores showed moderate negative correlations with BMI in men and women, the four IES-2 subscales showed different relationships with food intake. In contrast to the other subscales, unconditional permission to eat moderately correlated with poorer diet quality scores, and consistently showed associations with a more negative self-evaluation of eating behavior. The other three IES-2 subscales showed a few small positive and negative correlations with food intake, including small positive associations of diet quality scores in women, but not men, with eating for physical rather than emotional reasons and reliance on hunger and satiety cues. Further studies are needed to determine the impact of IE interventions on food intake.
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Affiliation(s)
- Caroline Horwath
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Désirée Hagmann
- Department of Health Science and Technology, Consumer Behavior, ETH Zurich, Universitaetstrasse 22, CHN J75.3, CH-8092, Zurich, Switzerland.
| | - Christina Hartmann
- Department of Health Science and Technology, Consumer Behavior, ETH Zurich, Universitaetstrasse 22, CHN J75.3, CH-8092, Zurich, Switzerland.
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86
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Cross-cultural adaptation of the intuitive eating scale-2: psychometric evaluation in a sample in Turkey. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-0024-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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87
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Brewer JA, Ruf A, Beccia AL, Essien GI, Finn LM, van Lutterveld R, Mason AE. Can Mindfulness Address Maladaptive Eating Behaviors? Why Traditional Diet Plans Fail and How New Mechanistic Insights May Lead to Novel Interventions. Front Psychol 2018; 9:1418. [PMID: 30250438 PMCID: PMC6139346 DOI: 10.3389/fpsyg.2018.01418] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/20/2018] [Indexed: 01/20/2023] Open
Abstract
Emotional and other maladaptive eating behaviors develop in response to a diversity of triggers, from psychological stress to the endless external cues in our modern food environment. While the standard approach to food- and weight-related concerns has been weight-loss through dietary restriction, these interventions have produced little long-term benefit, and may be counterproductive. A growing understanding of the behavioral and neurobiological mechanisms that underpin habit formation may explain why this approach has largely failed, and pave the way for a new generation of non-pharmacologic interventions. Here, we first review how modern food environments interact with human biology to promote reward-related eating through associative learning, i.e., operant conditioning. We also review how operant conditioning (positive and negative reinforcement) cultivates habit-based reward-related eating, and how current diet paradigms may not directly target such eating. Further, we describe how mindfulness training that targets reward-based learning may constitute an appropriate intervention to rewire the learning process around eating. We conclude with examples that illustrate how teaching patients to tap into and act on intrinsic (e.g., enjoying healthy eating, not overeating, and self-compassion) rather than extrinsic reward mechanisms (e.g., weighing oneself), is a promising new direction in improving individuals' relationship with food.
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Affiliation(s)
- Judson A. Brewer
- Center for Mindfulness in Medicine, Healthcare, and Society, Division of Mindfulness, University of Massachusetts Medical School, Worcester, MA, United States
| | - Andrea Ruf
- Center for Mindfulness in Medicine, Healthcare, and Society, Division of Mindfulness, University of Massachusetts Medical School, Worcester, MA, United States
| | - Ariel L. Beccia
- Center for Mindfulness in Medicine, Healthcare, and Society, Division of Mindfulness, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Gloria I. Essien
- Contemplative Studies, Brown University, Providence, RI, United States
| | - Leonard M. Finn
- Needham Wellesley Family Medicine PC, Wellesley, MA, United States
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, United States
| | - Remko van Lutterveld
- Center for Mindfulness in Medicine, Healthcare, and Society, Division of Mindfulness, University of Massachusetts Medical School, Worcester, MA, United States
| | - Ashley E. Mason
- Department of Medicine, Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, United States
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88
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Bégin C, Carbonneau E, Gagnon-Girouard MP, Mongeau L, Paquette MC, Turcotte M, Provencher V. Eating-Related and Psychological Outcomes of Health at Every Size Intervention in Health and Social Services Centers Across the Province of Québec. Am J Health Promot 2018; 33:248-258. [DOI: 10.1177/0890117118786326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report the outcomes of a Health at Every Size (HAES) intervention in a real-world setting. Design: Quasi-experimental design evaluating eating behaviors and psychological factors. Setting: The HAES intervention is offered in Health and Social Services Centers in Québec (Canada). Participants: For this study, 216 women (body mass index [BMI]: 35.76 [6.80] kg/m2) who participated to the HAES intervention were compared to 110 women (BMI: 34.56 [7.30] kg/m2) from a comparison group. Intervention: The HAES intervention is composed of 14 weekly meetings provided by health professionals. It focuses on healthy lifestyle, self-acceptance, and intuitive eating. Measures: Eating behaviors (ie, flexible restraint, rigid restraint, disinhibition, susceptibility to hunger, intuitive eating, and obsessive-compulsive eating) and psychological correlates (ie, body esteem, self-esteem, and depression) were assessed using validated questionnaires at baseline, postintervention, and 1-year follow-up. Analysis: Group, time, and interaction effects analyzed with mixed models. Results: Significant group by time interactions were found for flexible restraint ( P = .0400), disinhibition ( P < .0001), susceptibility to hunger ( P < .0001), intuitive eating ( P < .0001), obsessive–compulsive eating ( P < .0001), body-esteem ( P < .0001), depression ( P = .0057), and self-esteem ( P < .0001), where women in the HAES group showed greater improvements than women in the comparison group at short and/or long term. Conclusion: The evaluation of this HAES intervention in a real-life context showed its effectiveness in improving eating-, weight-, and psychological-related variables among women struggling with weight and body image.
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Affiliation(s)
- Catherine Bégin
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
- School of Psychology, Laval University, Québec, Canada
| | - Elise Carbonneau
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
- School of Nutrition, Laval University, Québec, Canada
| | | | - Lyne Mongeau
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
- School of Public Health, University of Montreal, Montreal, Canada
| | - Marie-Claude Paquette
- Institut national de santé publique du Québec, Québec, Canada
- Department of Nutrition, University of Montreal, Montreal, Canada
| | - Mylène Turcotte
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
- School of Nutrition, Laval University, Québec, Canada
| | - Véronique Provencher
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada
- School of Nutrition, Laval University, Québec, Canada
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89
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Dimitrov Ulian M, Pinto AJ, de Morais Sato P, B. Benatti F, Lopes de Campos-Ferraz P, Coelho D, Roble OJ, Sabatini F, Perez I, Aburad L, Vessoni A, Fernandez Unsain R, Macedo Rogero M, Toporcov TN, de Sá-Pinto AL, Gualano B, B. Scagliusi F. Effects of a new intervention based on the Health at Every Size approach for the management of obesity: The "Health and Wellness in Obesity" study. PLoS One 2018; 13:e0198401. [PMID: 29979699 PMCID: PMC6034785 DOI: 10.1371/journal.pone.0198401] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/20/2018] [Indexed: 01/08/2023] Open
Abstract
Health at Every Size® (HAES®) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes. This study examined multiple physiological, attitudinal, nutritional, and behavioral effects of a newly developed, intensive, interdisciplinary HAES®-based intervention in obese women. This was a prospective, seven-month, randomized (2:1), controlled, mixed-method clinical trial. The intervention group (I-HAES®; n = 39) took part in an intensified HAES®-based intervention comprising a physical activity program, nutrition counseling sessions, and philosophical workshops. The control group (CTRL; n = 19) underwent a traditional HAES®-based intervention. Before and after the interventions, participants were assessed for physiological, psychological, and behavioral parameters (quantitative data) and took part in focus groups (qualitative data). Body weight, body mass index, and waist and hip circumferences did not significantly differ within or between groups (P > 0.05). I-HAES® showed increased peak oxygen uptake and improved performance in the timed-stand test (P = 0.004 and P = 0.004, between-group comparisons). No significant within- or between-group differences were observed for objectively measured physical activity levels, even though the majority of the I-HAES® participants indicated that they were engaged in or had plans to include physical activity in their routines. I-HAES® resulted in improvements in eating attitudes and practices. The I-HAES® group showed significantly improved all Body Attitude Questionnaire subscale and all Figure Rating Scale scores (P ≤ 0.05 for all parameters, within-group comparisons), whereas the CTRL group showed slight or no changes. Both groups had significant improvements in health-related quality of life parameters, although the I-HAES® group had superior gains in the "physical health," "psychological health," and "overall perception of quality of life and health" (P = 0.05, 0.03, and 0.02, respectively, between-group comparisons) domains. Finally, most of the quantitative improvements were explained by qualitative data. Our results show that this new intensified HAES®-based intervention improved participants' eating attitudes and practices, perception of body image, physical capacity, and health-related quality of life despite the lack of changes in body weight and physical activity levels, showing that our novel approach was superior to a traditional HAES®-based program.
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Affiliation(s)
- Mariana Dimitrov Ulian
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Ana Jéssica Pinto
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Priscila de Morais Sato
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Fabiana B. Benatti
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- School of Applied Sciences, Universidade Estadual de Campinas, Limeira, Brazil
| | | | - Desire Coelho
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Odilon J. Roble
- Faculty of Physical Education, Universidade Estadual de Campinas, Campinas, Brazil
| | - Fernanda Sabatini
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Isabel Perez
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Luiz Aburad
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - André Vessoni
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Marcelo Macedo Rogero
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
- Food Research Center (FoRC), CEPID-FAPESP, Research Innovation and Dissemination Centers Sao Paulo Research Foundation, Sao Paulo, Brazil
| | | | - Ana Lúcia de Sá-Pinto
- Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fernanda B. Scagliusi
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
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90
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Winkens LH, van Strien T, Barrada JR, Brouwer IA, Penninx BW, Visser M. The Mindful Eating Behavior Scale: Development and Psychometric Properties in a Sample of Dutch Adults Aged 55 Years and Older. J Acad Nutr Diet 2018; 118:1277-1290.e4. [DOI: 10.1016/j.jand.2018.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 01/18/2018] [Indexed: 10/17/2022]
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91
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Dietary approaches to weight-loss, Health At Every Size® and beyond: rethinking the war on obesity. SOCIAL THEORY & HEALTH 2018. [DOI: 10.1057/s41285-018-0070-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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92
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93
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Landry M, Lemieux S, Lapointe A, Bédard A, Bélanger-Gravel A, Bégin C, Provencher V, Desroches S. Is eating pleasure compatible with healthy eating? A qualitative study on Quebecers' perceptions. Appetite 2018; 125:537-547. [DOI: 10.1016/j.appet.2018.02.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/12/2018] [Accepted: 02/27/2018] [Indexed: 12/22/2022]
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94
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Alblas EE, Folkvord F, Anschütz DJ, van 't Riet J, Granic I, Ketelaar P, Buijzen M. Investigating the impact of a health game on implicit attitudes towards food and food choice behaviour of young adults. Appetite 2018; 128:294-302. [PMID: 29807125 DOI: 10.1016/j.appet.2018.05.141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/24/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022]
Abstract
Improving diets by stimulating fruit and vegetable consumption might be beneficial, in particular when they substitute energy-dense products. The aim of present study was to investigate whether a health game can be used to positively affect healthy implicit attitudes (IAs) towards food and subsequent food choice behaviour of young adults. A 2 (Time: baseline vs. post-test) x 2 (Condition: health game vs. control game) x 2 (Baseline IAs: healthy IAs vs. less healthy IAs) mixed-subjects design was used with 125 participants (age: M = 20.17, SD = 1.88). IAs towards food were assessed at baseline and post-test using an Implicit Association Test (IAT). Additionally, food choice behaviour was assessed after game play. At baseline, the majority of participants had healthy IAs (i.e., favouring fruit over chocolate snacks). At post-test, significantly less healthy IAs were observed in the control condition, while this reduction was not significant in the health game condition. Regarding food choice behaviour, participants with healthy baseline IAs were more likely to select fruit in the health game condition than participants with healthy baseline IAs in the control game condition. However, participants with less healthy baseline IAs were less likely to select fruit in the health game condition than in the control condition. We found tentative support that health games can be used to influence IAs towards food and positively affect food choice behaviour. However, this influence was only observed for those with healthy baseline IAs. The current version of the health game would primarily benefit those already healthy and could negatively affect those that need the intervention most, so modifications are recommendable.
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Affiliation(s)
- Eva E Alblas
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
| | - Frans Folkvord
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Applied Social Science and Behavioural Economics Research Group, Universitat Oberta de Catalunya, Barcelona, Spain; Faculty of Social Sciences, Communication Science, VU University Amsterdam, The Netherlands
| | - Doeschka J Anschütz
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Isabela Granic
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Paul Ketelaar
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Moniek Buijzen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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95
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The Relationship Between Intuitive Eating and Postpartum Weight Loss. Matern Child Health J 2018; 21:1591-1597. [PMID: 28176035 DOI: 10.1007/s10995-017-2281-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective Postpartum weight loss is challenging for new mothers who report limited time and difficulties following traditional weight loss methods. Intuitive eating (IE) is a behavior that includes eating based on physical hunger and fullness and may have a role in encouraging weight loss. The purpose of this study was to examine the relationship between IE and postpartum weight loss. Methods Women 12-18 months postpartum completed a questionnaire regarding weight changes surrounding pregnancy, exercise, breastfeeding and intuitive eating using the Intuitive Eating Scale. Latent growth curve modeling was utilized to determine the relationship between IE, breastfeeding, weight gain during pregnancy, and postpartum weight trajectories. Results Participants (n = 50) were 28.5 ± 4.9 years old, had an average pre-pregnancy BMI of 26.4 ± 6.8 and the majority were married, and non-Hispanic white. The conditional model revealed that more intuitive eating practices predicted greater postpartum BMI decreases (Est. = -0.10, p < .05) when controlling for breastfeeding duration, exercise duration, and initial BMI and pregnancy BMI changes. Greater pregnancy BMI increases were associated with more rapid postpartum BMI decreases (Est. = -0.34, p < .001) while breastfeeding duration, exercise and initial BMI were not related. Conclusions for Practice Postpartum weight retention is a challenge for many women. Following a more intuitive eating approach to food consumption may encourage postpartum weight loss without the required weighing, measuring, recording and assessing dietary intake that is required of traditional weight loss programs. IE could offer an alternative approach that may be less arduous for new mothers.
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Saunders JF, Nichols-Lopez KA, Frazier LD. Psychometric properties of the intuitive eating scale-2 (IES-2) in a culturally diverse Hispanic American sample. Eat Behav 2018; 28:1-7. [PMID: 29156372 DOI: 10.1016/j.eatbeh.2017.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Intuitive eating is an adaptive eating tendency consistently associated with positive physical and mental health outcomes, including lower risk for obesity and eating disorders (EDs). Obesity rates are disproportionately high in Hispanic American populations, yet the properties of intuitive eating remain to be examined in such samples. METHOD The current study examined the psychometric properties of the Intuitive Eating Scale-2 (IES-2) in a Hispanic American sample of adult college students (N=482), and related IES-2 scores to levels of disordered eating, body mass index (BMI), fruit and vegetable consumption, and body shape satisfaction. RESULTS The final confirmatory factor analysis supported a three factor, 11 item measure with the subscales of Eating for Physical Rather Than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Body Food Choice Congruence. The Unconditional Permission to Eat subscale could not be replicated in the current sample. As predicted, scores on the revised measure differed by BMI category and body shape satisfaction, and correlated with disordered eating tendencies and fruit and vegetable consumption. CONCLUSION The current findings demonstrate that the modified IES-2 is better tailored to assess the cultural nuances influencing intuitive eating and can advance understanding how intuitive eating is understood and practiced in Hispanic Americans, compared to the original measure.
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Affiliation(s)
- Jessica F Saunders
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL 33199, United States.
| | - Kristin A Nichols-Lopez
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL 33199, United States.
| | - Leslie D Frazier
- Department of Psychology, Florida International University, 11200 SW 8th St, Miami, FL 33199, United States.
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97
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Sproesser G, Klusmann V, Ruby MB, Arbit N, Rozin P, Schupp HT, Renner B. The positive eating scale: relationship with objective health parameters and validity in Germany, the USA and India. Psychol Health 2017. [DOI: 10.1080/08870446.2017.1336239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Gudrun Sproesser
- Psychological Assessment and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Verena Klusmann
- Psychological Assessment and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Matthew B. Ruby
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Naomi Arbit
- Department of Nutrition, Columbia University, New York, NY, USA
| | - Paul Rozin
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Britta Renner
- Psychological Assessment and Health Psychology, University of Konstanz, Konstanz, Germany
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98
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US Registered Dietitian Nutritionists' Knowledge and Attitudes of Intuitive Eating and Use of Various Weight Management Practices. J Acad Nutr Diet 2017; 117:1419-1428. [PMID: 28619668 DOI: 10.1016/j.jand.2017.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 04/20/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Researchers have been advocating for a new weight-inclusive paradigm that focuses on health rather than weight. One important component of this model is intuitive eating. Although registered dietitian nutritionists (RDNs) are the nation's food and nutrition experts, RDNs' knowledge of and attitudes toward intuitive eating and use of traditional or restrictive strategies are unknown. OBJECTIVE The purpose of this study was to characterize RDNs' knowledge of and attitudes toward an intuitive eating lifestyle and describe use of traditional weight management and nonrestrictive lifestyle practices with clients. DESIGN This was a cross-sectional study. PARTICIPANTS A validated survey was distributed using online survey software to 88,834 RDNs. RESULTS There were 18,622 respondents who completed the survey (25%). The majority of RDNs were knowledgeable about intuitive eating, answering 71% of items correctly. The majority of RDNs had a positive view on each attitude item. RDNs who work in weight management reported using nonrestrictive/intuitive eating practices more than traditional/restrictive practices. RDNs who were women (P<0.001), had advanced education (P<0.001), worked in a private practice setting (P<0.001), completed at least one certificate of training in weight management (P<0.001), had more experience in weight management counseling (P<0.001), and had greater intuitive eating knowledge (P<0.001) were more likely to report greater use of nonrestrictive/intuitive eating practices. CONCLUSIONS This study provides evidence that RDNs are using an intuitive eating approach more often than traditional weight management practices.
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99
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Daundasekara SS, Beasley AD, O'Connor DP, Sampson M, Hernandez D, Ledoux T. Validation of the intuitive Eating Scale for pregnant women. Appetite 2017; 112:201-209. [DOI: 10.1016/j.appet.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
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100
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Clementi C, Casu G, Gremigni P. An Abbreviated Version of the Mindful Eating Questionnaire. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:352-356.e1. [PMID: 28391799 DOI: 10.1016/j.jneb.2017.01.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/25/2017] [Accepted: 01/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the psychometric properties of the Mindful Eating Questionnaire (MEQ). METHODS A total of 15 mindfulness experts evaluated the content of the 28 items and 5 factors of the MEQ. A sample of 1,067 Italian adults (61.4% women) completed the MEQ and other measures; 62 participants completed a 4-week test-retest. RESULTS Content analysis reduced the MEQ to 20 items. Exploratory and confirmatory factor analyses supported a 2-factor model based on awareness and recognition of hunger and satiety cues. Factors showed adequate internal consistency (α = .75 and .83, respectively) and test-retest reliability (intraclass correlation coefficient = 0.73 and 0.85, respectively), and were associated in expected ways, although with small to moderate effect sizes, with general mindfulness, meditation experience, yoga practice, not being on a diet plan, and body mass index categories. CONCLUSIONS AND IMPLICATIONS Findings provided evidence of validity and reliability for the 20-item MEQ and support its use by clinicians and researchers for addressing eating-related issues.
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Affiliation(s)
| | - Giulia Casu
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Paola Gremigni
- Department of Psychology, University of Bologna, Bologna, Italy.
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